Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Monday, July 10, 2006

Can we cage the monster?

Much business to do, in the fields of public health ethics and the perilous times, but for right now I'll stick to the knitting. The Organization for Economic Cooperation and Development, which is the club of rich countries, has released OECD Health Data 2006, which compares health statistics for its members. If you're really into this stuff, you can buy it here for a mere hundred bucks, or eighty Euros. Meanwhile, Rory Watson in BMJ (to which you can subscribe for a mere $37/year, or 30 Euros) summarizes the info on total health care expenditures.

It turns out that spending has increased faster than GDP in every wealthy country except Finland. The U.S. is still way in front - at 15.3%, up from 12% in 1990 -- but as our friend Ana pointed out a few days ago, Switzerland is trying to catch up, now a distant but solid second at 11.6%. The gap between the U.S. and the other wealthy countries is huge. Japan, whose people are very healthy, spends 8% of GDP on health care.

In the U.S. today, the average yearly cost for a family plan was $10,800 in 2005. It so happens that a full-time, minimum wage worker earns $11,000. In other words, if that worker had to pay for health insurance for a family, it would consume 100% of her income. Most workers don't necessarily realize this, but the employer share of their health care comes out of what otherwise would have been their wages. That's what economic theory and empirical studies show. So, as David Blumenthal in NEJM last week points out, there's a whole worker worth of cash being siphoned out of your paycheck.

This obviously has to stop somewhere, and there are basically two ways it can happen.

a) More and more people get squeezed out entirely by the high cost of health insurance, and inequalities in access widen. Rich people get the Cadillac ride, everybody else hitchhikes on a passing manure spreader if they're lucky enough to catch one;b) We come up with a universal plan that limits the resources spent on health care and allocates them in a way that a social consensus accepts as fair.

Right now, this is happening in frog boiling mode, but an economic downturn will throw us in the fryolator.